Myocardial Infarction (MI)

You are the nurse caring for a 48-year Leslie Collins, retired army officer for the United States military, He arrives to the emergency department after experiencing chest pain and shortness of breath. His EKG indicated he had a myocardial infarction (MI). He has a history of hypertension and high cholesterol. He states he used to smoke about 15 years ago, he has no other reported risk factors.
Based on this information, your prior knowledge of this client (refer to medical card from the Collins-Kim family tree interactive), and your knowledge of the pathophysiology of myocardial infarction (MI), respond to the following prompts:

  1. Thoroughly explain the pathophysiology of myocardial infarction (MI). Use a scholarly or authoritative source to support your answer.

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Sample Answer


Pathophysiology of Myocardial Infarction (MI)

Myocardial infarction (MI), also known as a heart attack, occurs when the blood supply to a portion of the heart muscle is blocked, causing damage or death to the heart muscle. The most common cause of MI is atherosclerotic plaque rupture, which occurs when a buildup of plaque in the coronary arteries ruptures and blocks the blood flow to the heart muscle. Other causes of MI include coronary artery spasm, blood clots, and embolism.

Full Answer Section



The pathophysiology of MI can be divided into four stages:

  1. Ischemia: When the blood supply to the heart muscle is blocked, the heart muscle becomes ischemic, meaning that it is not receiving enough oxygen. This leads to a buildup of lactic acid and other metabolites in the heart muscle, which can cause damage to the heart muscle cells.
  2. Injury: If ischemia persists for more than a few minutes, the heart muscle cells will begin to die. This is known as myocardial injury.
  3. Inflammation: After myocardial injury, the body’s inflammatory response is activated. This leads to the release of inflammatory cells and cytokines, which can further damage the heart muscle.
  4. Healing: Over time, the body will begin to heal the damaged heart muscle. This process is known as myocardial healing.

The severity of an MI depends on the size and location of the area of the heart muscle that is affected. A small MI may not cause any symptoms, while a large MI can cause life-threatening complications, such as heart failure, arrhythmias, and sudden cardiac death.

Risk Factors for MI

There are a number of risk factors for MI, including:

  • Age: The risk of MI increases with age.
  • Sex: Men are at higher risk of MI than women.
  • Family history: A family history of heart disease is a major risk factor for MI.
  • High cholesterol: High levels of cholesterol in the blood can lead to atherosclerosis and plaque buildup in the coronary arteries.
  • High blood pressure: High blood pressure can damage the coronary arteries and make them more likely to rupture.
  • Smoking: Smoking damages the blood vessels and increases the risk of blood clots.
  • Diabetes: Diabetes damages the blood vessels and increases the risk of blood clots.
  • Obesity: Obesity is a risk factor for high blood pressure, high cholesterol, and diabetes, all of which are risk factors for MI.

Symptoms of MI

The most common symptom of MI is chest pain. The pain is often described as a pressure or squeezing sensation in the chest. The pain may radiate to the shoulders, arms, neck, or jaw. Other symptoms of MI include:

  • Shortness of breath
  • Nausea and vomiting
  • Sweating
  • Lightheadedness or dizziness
  • Palpitations (feeling like the heart is racing or pounding)

Treatment for MI

The goal of treatment for MI is to restore blood flow to the heart muscle as quickly as possible. This can be done with medications that dissolve blood clots (thrombolytics) or with a procedure called coronary angiography and stenting.

Coronary angiography is a procedure in which a thin tube is inserted into an artery in the arm or leg and threaded up to the heart. Once the tube is in place, a dye is injected into the blood vessels to make them visible on X-ray images. This allows the doctor to see any blockages in the coronary arteries.

If a blockage is found, a stent can be placed in the artery to open up the blockage and improve blood flow to the heart muscle. A stent is a small metal mesh tube that is inserted into the artery and expanded to hold the artery open.

In some cases, surgery may be necessary to open up a blocked coronary artery. The most common type of surgery for MI is coronary artery bypass grafting (CABG). In CABG surgery, a vein or artery from another part of the body is grafted onto the coronary artery to bypass the blockage and improve blood flow to the heart muscle.

Prevention of MI

The best way to prevent MI is to reduce your risk factors. This can be done by making lifestyle changes, such as:

  • Quitting smoking
  • Eating a healthy diet
  • Exercising regularly
  • Maintaining a healthy weight
  • Managing your blood pressure and cholesterol levels

If you have a family history of heart disease or other risk factors for MI, it is important to talk to your doctor about ways to reduce your risk.


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